Social determinants of survival in head and neck cancer.
Authors: Kim Robyn Kennedy, Daren Joseph Gibson, Stephanie Flukes, Lisa Jane Spalding, Chandra Sai Diwakarla, Andrew David Redfern
Journal: Journal of Clinical Oncology (2023)

e18008 Background: Social demographics and health inequalities are associated with adverse outcomes in cancer. Methods: We conducted a retrospective review of 320 Head and Neck Cancer patients between 2013-2021 in a tertiary centre in Western Australia. We matched 80 Aboriginal patients with 240 non-Aboriginal patients by disease site, histology, age, and rurality. Data collected included tumour site, patient demographics, treatments, recurrences, and survival outcomes. An initial univariate analysis was performed using Chi-Square and Kaplan Meier analyses; however a multivariate analysis will be conducted for subsequent publication. Results: Median follow-up was 2.6 years (range 16 days to 9 years). 44% of patients underwent curative intent radiotherapy or chemoradiotherapy, 38% had surgery (+/- adjuvant therapies), 9% had palliative treatments, and 9% had best supportive care. Overall survival (OS) using Kaplan-Meier was inferior for Aboriginal patients compared with non-Aboriginal patients; 1 year survival (YS) 59% vs 85% and 5YS 32% vs 60% (p &lt; 0.00001). Of patients receiving curative intent treatment, relapse occurred in 47% of Aboriginal patients compared with 29% of non-Aboriginal patients (p = 0.01), with inferior progression-free survival (PFS) 1 yr PFS 71% vs 81% and 5yr PFS 52% vs 72%, p = 0.006. 2YS was highest in regional patients (77%), followed by metropolitan (68%), and lowest in remote patients (61%), p = 0.04. 21% of remote patients opted for palliative treatment despite curative treatment being recommended, compared with 3% of regional and 4% of metropolitan patients. Amongst patients receiving curative treatment (81%), metropolitan patients had the highest risk of relapse (42%), compared with remote (31%) and regional (23%), p = 0.02. Despite this, in the same group of treated patients, remote patients had the lowest survival (2YS 88% regional, 80% metropolitan, 75% remote, p = 0.04). Ever smokers had lower 1YS (91% vs 76%, p = 0.03), a higher risk of relapse (28% vs 21%, p = 0.01), and a lower likelihood of disease-free survival (53% vs 74%, p = 0.01) compared to never smokers. Alcohol excess was associated with inferior 1YS (84% 0-4 std/d, 85% 5-10 std/d, 57% &gt; 10 std/d, p = 0.00004), and a higher risk of relapse (19% for non-drinkers, 35% 1-4 std/d, 27% 5-10 std/d, and 64% for &gt; 10 std/d, p = 0.00007). Marital stability was associated with improved 1YS (88% married, 78% widowed, 78% de facto, 76% divorced, 65% single, p = 0.004). Single patients had the lowest likelihood of disease-free survival (42%), followed by divorced (50%), de facto (50%), and widowed (65%). Married patients had the best disease-free survival (66%), p = 0.002. Non-English speaking status was associated with inferior 1YS (79% vs 40%, p = 0.006). Conclusions: Aboriginal status, rurality, smoking, high alcohol consumption, single or divorced individuals, and non-English speaking were all associated with poorer outcomes.